Keloid Scars: Why Do They Keep Growing and Recurring? We’ve Summarized the Basics of Treatment

A keloid is a rather unique type of scar that forms at the site of a healed wound and spreads beyond the original boundaries of the injury to the surrounding normal skin. Unlike ordinary scars that fade over time, keloids do not disappear on their own. In fact, if left untreated, they can grow larger, itch, and become painful. Therefore, the realistic goal of keloid treatment is not "complete elimination," but rather reducing its size, soothing the symptoms, and preventing it from growing again.

Let me clarify one thing first: keloids cannot be easily resolved by surgical excision alone. It is well known that simply cutting them out carries a 45% to 100% chance of recurrence. For this reason, modern approaches prioritize combining multiple methods to suppress the excessive activity of the tissue rather than simply cutting it away. At Gangnam Onlif Clinic, we also treat keloids from this perspective of "suppression and management."

🔍 Keloid vs. Hypertrophic Scar: What's the Difference?

Since both are raised scars, they are easy to confuse. However, because their treatment directions are completely different, distinguishing between them is crucial.

The biggest difference lies in the boundaries. A keloid spreads beyond the original wound area into normal skin. On the other hand, a hypertrophic scar remains strictly within the boundaries of the original wound and may gradually flatten on its own after 1 to 2 years.

If a scar grows larger, becomes itchy, and turns redder over time, it is highly likely to be a keloid. However, it is difficult to judge by sight alone, and because the activity of the tissue must also be evaluated, getting a professional diagnosis is the most accurate way to confirm.

📌 Key Summary: If a scar spreads beyond the original wound boundary and does not disappear on its own, it is highly likely a keloid. If it stays within the boundary and improves over time, it is likely a hypertrophic scar.

🧬 Why Do Keloids Form?

When the skin repairs a wound, a protein called collagen is produced. The problem with keloids is that this collagen accumulates excessively, far more than necessary. It is as if the tissue continues to grow with broken brakes.

Several risk factors overlap here:

• Skin Tension: They frequently occur and recur in areas where the skin is tightly stretched, such as the sternum (center of the chest), shoulders, and upper back.

• Skin Type: Darker skin tones (Fitzpatrick types IV to VI) tend to have a higher incidence rate.

• Family History & Age: They mainly occur in people aged 10 to 30, and having a family member with keloids increases the risk.

• Irritation: Piercings, tattoos, acne inflammation, and unnecessary surgeries can act as triggers.

For reference, the prevalence varies greatly by race, ranging from about 0.09% to 16%. It is reported to be approximately 5 to 15 times higher in Black, Asian, and Hispanic populations compared to Caucasians.

In South Korea, BCG vaccine scars can also serve as a helpful clue. If the mark left by the BCG vaccination you received as a child swelled up exceptionally large, you may suspect a keloid-prone constitution. Of course, this is only a reference signal and not a definitive diagnosis.

📌 Key Summary: Keloids are fundamentally caused by collagen hyperproliferation. Areas under high tension, dark skin tones, family history, and skin irritation increase the risk.

💉 Keloid Treatment: What Methods Are Available?

The standard approach for keloid treatment is combination therapy using multiple methods rather than a single treatment. The combination varies depending on the location, size, and individual constitution. Here are the representative methods:

Intralesional Steroid Injection

This is the most widely used primary treatment. An ingredient called triamcinolone acetonide is injected directly into the scar to suppress the hyperproliferating tissue. It is usually repeated at intervals of 3 to 4 weeks, with response rates reported to be between 50% and 100% depending on literature. However, because there can be side effects such as recurrence or thinning of the skin, controlling the concentration and interval is crucial.

Combination Drug Injections

When response to steroids alone is weak or to reduce side effects, other drugs are used in combination. **5-Fluorouracil (5-FU)** is used as an alternative that inhibits the proliferation of cells that make tissue, thereby reducing the side effect of skin atrophy. Other options mentioned for combination injections include bleomycin and verapamil, which regulates calcium channels.

Laser Treatment

**Pulsed Dye Laser (PDL)** is used to improve the redness and vascular erythema of keloids, while fractional lasers help refine the surface texture or assist in drug absorption. They are usually used in combination with other treatments rather than as a standalone therapy.

Cryotherapy

This method freezes and destroys hyperproliferating tissue using liquid nitrogen. When combined with steroid injections, the effectiveness increases, but caution is required for darker skin types as it can cause hypopigmentation (lightening of the skin).

Silicone Gel & Silicone Sheets

This is a non-invasive auxiliary and preventive method that does not involve needles. It is only effective if applied consistently for at least 12 hours a day for at least 2 to 3 months. If used for only a short period and stopped, you cannot expect results.

Compression Therapy

For ear keloids in particular, wearing compression earrings for several months after excision is key to preventing recurrence. For burn scars, compression garments are also utilized.

Post-Surgical Radiation Therapy

Combining radiation therapy within 24 to 72 hours after surgical excision is known to reduce the recurrence rate to under 10%. However, this approach must be taken with caution near sensitive organs like the thyroid, breasts, and gonads, as well as in children, adolescents, and pregnant women.

📌 Key Summary: The basic framework of keloid treatment centers on steroid injections, combined with silicone, compression, laser, or cryotherapy tailored to the individual's condition.

🏥 How Does Onlif Treat Keloids?

Onlif Clinic prioritizes non-surgical methods that suppress tissue activity from a dermatological perspective, rather than surgical incisions. This is because keloids cannot be resolved simply by cutting them out.

First, we diagnose the activity of the scar to see whether it is currently actively growing or in a stable state. Next, we use lasers to relieve tissue adhesion, inject therapeutic agents into the lesion, and combine compression therapy if necessary to suppress hyperproliferation.

Keloid management is a concept of flexible care based on activity levels rather than ending in a fixed number of sessions. Initially, we usually recommend 3 to 6 or more treatments at intervals of 3 to 4 weeks, and we continue management even after stabilization to prevent recurrence.

Onlif employs a specialized doctor system where practitioners take charge of procedures they excel in, and scars are also designed individually through a 1:1 analysis. True to our philosophy, "Because you are precious, we do not change you," we aim for natural recovery and stabilization instead of excessive irritation.

📌 Key Summary: Based on activity diagnosis, Onlif prioritizes non-surgical management that combines lasers, intralesional injections, and compression therapy to suppress recurrence and worsening.

🛡️ Why Prevention Is the Best Cure for Keloids

Keloids are not a concept of a complete cure, but rather a concept of management. Therefore, if you suspect you have a keloid-prone constitution, the wisest choice is to avoid creating skin wounds in the first place.

• Avoid non-essential piercings, tattoos, and unnecessary surgeries.

• Manage acne inflammation before it leaves scars.

• If a wound does occur, manage it early with silicone products.

• If you have a family history or clues like a prominent BCG scar, seek a consultation in advance.

One reassuring fact is that keloids are non-contagious and are benign scars that extremely rarely turn into cancer. Rather than being afraid, a consistent management attitude is much more important.

📌 Key Summary: Although keloids are benign scars, they recur frequently. Therefore, if you have a predisposed constitution, prevention by avoiding unnecessary skin irritation is the best approach.

❓ Frequently Asked Questions (FAQ)

Can keloids be completely cured, or must they be managed for life?

Instead of complete elimination, the realistic goal is to reduce size, alleviate symptoms, and prevent recurrence. Since there are genetic factors, it is safer to continue regular management even after they stabilize.

Why do they recur after surgical excision?

If keloids are treated with simple excision alone, the recurrence rate is very high, ranging from 45% to 100%, and sometimes they grow even larger. Therefore, we prioritize approaches that suppress excessive tissue activity using injections, compression, and lasers rather than cutting them out.

How many times do I need to get steroid injections?

They are usually repeated at 3 to 4-week intervals, and depending on the condition and response, 3 to 6 or more initial sessions may be needed. Since pain can be a concern, we perform the actual procedures in a way that minimizes discomfort.

Can I know in advance if I have a keloid-prone constitution?

You can suspect it if you have a family history or if past wounds swelled exceptionally large. In Korea, whether a prominent BCG vaccine scar remains is used as a reference signal, but confirmation requires a professional diagnosis.

Which is better, silicone sheets or silicone gel?

Both are non-invasive auxiliary methods, and the key is consistency rather than the type. They must be used continuously for at least 12 hours a day for at least 2 to 3 months to be effective. For areas where sheets are difficult to apply, gel can be more convenient.

The keloid area is itchy and painful. Is this a sign of worsening?

Itching, pain, and redness can be signs that the keloid is active. If you feel like the scar is gradually growing, it is best not to leave it neglected and to have its activity evaluated.

Are scar ointments effective for keloids?

While they can be helpful as an aid for regular scars, it is difficult to reverse established keloids with ointment alone. It is more realistic to approach them as a tool for early preventive care, such as silicone products.

Things to Check Before Choosing a Clinic for Keloid Scar Treatment

Even for the same procedure, the results and recovery process can vary depending on where, by whom, and how it is performed.

Asking these questions during your consultation will help you make an informed decision:

• Do they perform this procedure frequently? — Every clinic has different focus treatments. Check if they regularly perform keloid scar treatments.

• Can I verify the products and equipment used? — Ask if you can verify the product names and authenticity during your consultation (e.g., whether they are officially imported and approved products, and if there is an unboxing verification process).

• Do they explain the breakdown of costs? — Rather than just hearing a lump sum, you should receive an explanation of what product is used, how much, and on what area to make an accurate judgment.

• Do they design the treatment based on the whole face? — Even for the same procedure, the injection locations and amounts vary depending on facial shape, skin condition, and asymmetry.

• Do they explain side effects and the recovery process first? — It is better to choose a clinic that informs you of potential adverse reactions and how to cope with them, rather than a consultation that only speaks of expected positive changes.

• Is there a way to follow up after the procedure? — Check if there is a scheduled time for follow-up, a way to contact them if there are issues, and established criteria for re-visiting.

How Onlif Clinic Performs Keloid Scar Treatment

• We divide responsibilities — Based on the belief that a single doctor should not handle every single procedure, Onlif divides medical treatment among doctors specialized in their respective fields.

• We verify products and equipment during the consultation — We guide you through the products used and the unboxing verification process during the consultation phase.

• Costs are guided along with the treatment plan after diagnosis — Since the treated area, volume, and scope differ for each individual, we explain exactly what is being used and how much it costs.

• We design based on overall facial balance — We look at the face through the three pillars of texture, balance, and signs of youth. Our plans aim to tidy up areas that obscure your natural look rather than altering your actual features.

• We discuss adverse reactions and the recovery process beforehand — Along with the expected changes, we guide you through individual variations, possible side effects, and coping strategies prior to the procedure.

• We monitor progress after the procedure — We provide guidance on follow-up visits and contact channels if verification is needed during the recovery period.

If you are considering keloid scar treatment, it is best to first check what is possible and what is difficult in your current condition.

An accurate diagnosis and treatment plan can only be determined through an in-person medical examination. Please verify through a consultation at Gangnam Onlif Clinic.